Nevin Manimala

BMC Gastroenterol. 2025 Feb 19;25(1):93. doi: 10.1186/s12876-025-03684-7.

ABSTRACT

BACKGROUND: Gastrointestinal bleeding is a significant cause of morbidity and mortality among emergency unit patients. Several scoring systems are verified for predicting hospitalization and mortality such as Glasgow Blatchford Bleeding Score (GBS), AIMS65 score, Rockall score (RS), and International Bleeding Risk Score (INBS; ABC score). The aim of this study is to evaluate the efficacy and predictive value of these scoring systems.

METHODS: Adult emergency unit patients with gastrointestinal bleeding were retrospectively enrolled. The age, gender, complaints at admission, vitals and examination results, laboratory findings, outcomes, blood transfusion status, and endoscopic interventions were all reported, and GBS, AIMS65, RS, and INBS (ABC) scores were calculated individually for all enrollies.

RESULTS: A total of 311 patients were included. The median age of participants was 70 years (IQR (25-75%): 59-81), and 202 (65%) of them were male. The efficacy of all four scoring systems (GBS, AIMS65, RS, and INBS (ABC)) in predicting hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality was found to be statistically significant (p < 0.05 for all). ROC-AUC analysis was revealed that while GBS is the most beneficial in predicting hospitalization, INBS (ABC) has the best predictive value on mortality. Besides, the only scoring model with predictive value in determining the need for endoscopic intervention was RS (p < 0.05).

CONCLUSION: The present study showed that, among adult emergency unit patients with gastrointestinal bleeding, GBS, AIMS65, RS, and INBS (ABC) scores could successfully predict hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality. However, the only scoring system that could be used to determine the need of endoscopic intervention is RS. Finally, we believe further studies with prospective enrollment would be beneficial for more accurate conclusions.

PMID:39972434 | DOI:10.1186/s12876-025-03684-7

BMC Public Health. 2025 Feb 19;25(1):679. doi: 10.1186/s12889-025-21850-0.

ABSTRACT

Acrylamide (AA) is a ubiquitous neurotoxic contaminant. Our objectives were to evaluate associations of internal AA exposure with sleep health outcomes. Data from 2753 adults aged 20-79 years in the National Health and Nutrition Examination Survey (NHANES) was utilized. Internal AA exposure was assessed using hemoglobin adducts and urinary biomarkers. Short sleep duration (SSD) and self-reported trouble sleeping were employed as indicators of sleep health. Markers of systemic inflammation were calculated. Each one-unit increase in ln-transformed hemoglobin adducts of acrylamide (HbAA), hemoglobin adducts of glycidamide (HbGA) and HbAA + HbGA and creatinine-adjusted urinary N-Acetyl-S-(2-carbamoylethyl)-L-cysteine concentration was statistically significantly associated with 1.37-fold (95% confidence interval [CI]: 1.16, 1.62; p = 0.002), 1.41-fold (95%CI: 1.19, 1.68; p = 0.002), 1.43-fold (95%CI: 1.19, 1.70; p = 0.001), and 1.24-fold (95%CI: 1.08, 1.42; p = 0.007) risk in SSD, respectively. The significant associations were strengthened in smokers after stratification by smoking status. Higher AA hemoglobin biomarkers predicted increases in markers of systemic inflammation. In conclusion, internal AA exposure was associated with an increased risk of SSD and elevated systemic inflammation among United States adults. The findings shed light on the potential effects of AA’s health threat and future research is warranted to develop intervention strategies.

PMID:39972427 | DOI:10.1186/s12889-025-21850-0

BMC Psychiatry. 2025 Feb 19;25(1):146. doi: 10.1186/s12888-025-06567-z.

ABSTRACT

BACKGROUND: Obsessive-compulsive symptoms are mental health conditions marked by the presence of obsessions and/or compulsions. Even though significant portion people with schizophrenia are reportedly affected by obsessive-compulsive symptoms, there is scarce of information related to this topic in Africa, and particularly in study area.

OBJECTIVE: This study aimed to assess the magnitude and associated factors of obsessive‒compulsive symptoms among people with schizophrenia attending services at referral hospitals in Eastern Ethiopia from February 15 to March 15, 2024.

METHODS: An institutional-based, cross-sectional study was conducted among adults with schizophrenia. Systematic sampling was used to select 422 study participants. The Yale-Brown Obsessive-Compulsive Scale was used to assess obsessive-compulsive symptoms. Data entry and analysis were performed by EpiData 4.6 and STATA 14, respectively. Bivariable and multivariable logistic regression were performed, and variables with p values < 0.05 were considered statistically significant.

RESULTS: The proportion with obsessive‒compulsive symptoms in this study was 44.07% (95% CI, 39.33%-48.92%). After adjusting for possible confounders, duration of schizophrenia from 3-4 years (AOR = 3.41; 95% CI, 1.28-9.05), duration of schizophrenia 5 years and above (AOR = 6.08; 95% CI, 2.26-16.31), current use of alcohol (AOR = 2.12; 95% CI, 1.09-4.12), current use of khat (AOR = 6.09; 95% CI, 3.15-11.74), being a probable case of anxiety (AOR = 3.57; 95% CI, 1.95-6.53), being a probable case of depression (AOR = 4.56; 95% CI, 2.39-8.66), being on Risperidone (AOR = 5.08; 95% CI, 2.52-10.23) and being on Olanzapine (AOR = 5.95; 95% CI, 2.72-13.04) were significantly associated with obsessive‒compulsive symptoms. CONCLUSIONS AND RECOMMENDATION: The prevalence of obsessive‒compulsive symptoms was relatively high. Timely detection and appropriate interventions are crucial and special consideration is better to be given for those with comorbid substance use, comorbid anxiety and depression, as well as those taking second-generation antipsychotics.

PMID:39972414 | DOI:10.1186/s12888-025-06567-z

Clin Transl Sci. 2025 Feb;18(2):e70117. doi: 10.1111/cts.70117.

ABSTRACT

There has been a growing trend that activities relating to clinical trials take place at locations other than traditional trial sites (hence decentralized clinical trials or DCTs), some of which are at settings of real-world clinical practice. Although there are numerous benefits of DCTs, this also brings some implications on a number of issues relating to the design, conduct, and analysis of DCTs. The Real-World Evidence Scientific Working Group of the American Statistical Association Biopharmaceutical Section has been reviewing the field of DCTs and provides in this paper considerations for decentralized trials from a statistical perspective. This paper first discusses selected critical decentralized elements that may have statistical implications on the trial and then summarizes regulatory guidance, framework, and initiatives on DCTs. More discussions are presented by focusing on the design (including construction of estimand), implementation, statistical analysis plan (including missing data handling), and reporting of safety events. Some additional considerations (e.g., ethical considerations, technology infrastructure, study oversight, data security and privacy, and regulatory compliance) are also briefly discussed. This paper is intended to provide statistical considerations for decentralized trials of medical products to support regulatory decision-making.

PMID:39972404 | DOI:10.1111/cts.70117

Diabetes Obes Metab. 2025 Feb 19. doi: 10.1111/dom.16272. Online ahead of print.

ABSTRACT

AIMS: To determine the impact of body roundness index (BRI) on the 10-year risk of cardiovascular disease (CVD) and all-cause mortality in Chinese adults.

MATERIALS AND METHODS: We utilized data from a nationwide prospective cohort of 165 785 Chinese adults (aged ≥40 years, free of CVD and cancer at baseline), which was extracted from the China Cardiometabolic Disease and Cancer Cohort (4C). Cox regression and restricted cubic splines quantified BRI-outcome associations and identified optimal BRI cutoffs.

RESULTS: During a median follow-up of 10.1 years, we documented 10 538 CVD events and 8679 deaths. A monotonic increasing dose-response association was observed between BRI and CVD risk, while BRI and all-cause mortality exhibited a U-shaped relationship (p for non-linear <0.001), with the nadir at a BRI of 3.9. Gender differences indicated that increased CVD risk was associated with higher BRI in men. As age increases, the excess risk of CVD and mortality associated with BRI diminishes, with a significant harmful effect of low BRI observed on mortality in individuals aged ≥75 years. Moreover, the inclusion of BRI in the model significantly enhanced the C-statistic for CVD prediction by 0.00412 (p <0.001) and for mortality prediction by 0.00045 (p = 0.0097).

CONCLUSIONS: Our findings indicate a positive association between BRI and CVD and a U-shaped association between BRI and mortality. These findings underscore the importance of the BRI in assessing the risk of CVD and all-cause mortality, particularly when considering different genders and age groups.

PMID:39972403 | DOI:10.1111/dom.16272

Acta Neuropathol Commun. 2025 Feb 19;13(1):34. doi: 10.1186/s40478-025-01939-8.

ABSTRACT

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) have increasingly been reported to impact the brain metastatic process of solid tumors. However, data on intra-individual differences between primary tumor and brain metastasis (BM), as well as their correlation with clinical outcome parameters, is scarce.

METHODS: We retrospectively identified patients who received resection of the primary tumor and BM between 01/1990 and 10/2022. Density quantification of TAMs (CD68⁺, CD163⁺) and TILs (CD3⁺, CD8⁺, CD45RO⁺, FOXP3⁺) was performed by immunohistochemical staining of matched tumor tissue samples. Images were processed with QuPath software and heterogeneity of generated heatmaps was measured by Shannon Entropy. Time-to-BM (TTBM) was defined as the time from diagnosis of the primary tumor until the first diagnosis of BM.

RESULTS: In total, 104 patients (46.2% female; median age 57.3 years at BM diagnosis) were included: 78/104 (75%) non-small cell lung cancer, 18/104 (17%) breast cancer, 8/104 (8%) renal cell carcinomas. Densities of CD3⁺ (p < 0.001) and CD8⁺-TILs (p < 0.001) were higher in primary tumor samples, while CD68⁺ (p = 0.035) and CD163⁺-TAM densities (p < 0.001) were higher in the matched BM. Higher CD3⁺, CD8⁺-TILs and CD163⁺-TAMs densities in primary tumors were associated with shorter TTBM (p = 0.005, p = 0.015 and p = 0.006, respectively). Higher entropies of CD3⁺ (p < 0.001) and FOXP3⁺ (p = 0.011) TILs were observed in primary tumors compared to BM. Longer TTBM was associated with higher entropy of FOXP3⁺ TILs (p = 0.024) and lower entropy in CD163⁺ TAMs (p = 0.039). No significant associations of immune cell densities or entropies with OS after BM diagnosis were found.

DISCUSSION: By utilizing a unique cohort of matched primary tumor and BM tissue samples, we could demonstrate higher TIL densities in primary tumors and higher TAM densities in BM, respectively. Higher cell densities of CD3⁺, CD8⁺-TILs and CD163⁺-TAMs in primary tumors were associated with shorter TTBM, while a larger difference between CD3⁺ and CD8⁺ densities between primary tumor and BM was associated with longer TTBM. These findings highlight the potential of targeting TAMs as a therapeutic strategy to mitigate the development of brain metastases.

PMID:39972401 | DOI:10.1186/s40478-025-01939-8

BMC Psychol. 2025 Feb 19;13(1):140. doi: 10.1186/s40359-025-02423-7.

ABSTRACT

BACKGROUND: Facial attractiveness, influenced by dental esthetics, impacts self-perception and social interactions. The rise of social media has further fueled the demand for cosmetic dental treatments. This study aimed to examine the influence of self-esteem on the inclination of dentists, dental students, and laypeople toward esthetic dental treatments.

METHODS: This cross-sectional study involved 410 participants, including dentists, dental students, and laypeople, selected through convenience sampling. Data were collected using a questionnaire that captured sociodemographic characteristics, oral hygiene status, previous experience with esthetic treatments, inclinations toward esthetic dental treatments, and self-esteem levels using the Rosenberg Self-Esteem Scale (RSES). The questionnaire, created on the Porsline© website, was distributed via social media platforms. Data were analyzed using SPSS version 21, employing the Chi-square test and logistic regression, with a p-value of less than 0.05 considered statistically significant.

RESULTS: The RSES showed that 16.3% of participants had low self-esteem, while 83.7% had high self-esteem. Among participants with previous cosmetic procedures, 84.3% expressed interest in pursuing additional treatments compared to 47.7% of those without such experience (P < 0.01). Among dental professionals, 38.3% of high and 37.5% of low self-esteem individuals expressed interest in cosmetic treatments (P = 0.42), while among laypeople, 66.6% of high and 82.2% of low self-esteem individuals indicated interest (P = 0.04). Regardless of profession, 66.7% of individuals with low self-esteem and 55.4% of those with high self-esteem expressed interest in esthetic treatments (P = 0.08). RSES scores varied significantly across age groups, with participants aged > 45 years showing the highest scores (P = 0.03). Regression analysis indicated that laypeople were more likely to seek esthetic dental treatments than dentists or dental students (OR = 3.02, 95% CI = 1.88-4.83). Participants with a history of esthetic dental treatments were also more likely to pursue further procedures (OR = 5.39, 95% CI = 2.97-9.77).

CONCLUSIONS: Self-esteem significantly correlates with laypeople’s inclination toward cosmetic dental treatments. Dentists and dental students tend to express less interest in such procedures, likely due to their understanding of potential long-term complications. Additionally, individuals with prior experience in esthetic dental treatments showed greater interest in pursuing further treatments.

PMID:39972400 | DOI:10.1186/s40359-025-02423-7

Health Res Policy Syst. 2025 Feb 19;23(1):20. doi: 10.1186/s12961-025-01289-w.

ABSTRACT

BACKGROUND: Learning healthcare communities (LHCCs) have been proposed as a next-generation evolution of learning health systems that can advance health equity; however, a practical mechanism for enabling the active and continuous community engagement required for one has not yet been described in the literature. Recognizing that community-based participatory research (CBPR) could potentially meet this need, a team at the Montefiore Medical Center/Albert Einstein College of Medicine designed a novel evidence-based CBPR model – Bridging Research, Accurate Information and Dialogue (BRAID) – that initiates meaningful, longitudinal dialogues to foster bidirectional trust between researchers, clinicians, scientists and communities.

METHODS: A mixed-methods cohort study of two BRAID cohorts was conducted between 2022 and 2023. Eligible participants were recruited from the Bronx, New York, United States and convened in a series of conversation circles. Multimodal data was collected from all participants, including quantitative pre- and post-series surveys and same-day conversation circle feedback forms. Surveys were administered using SurveyMonkey and descriptive statistics were completed in Excel and SPSS.

RESULTS: A total of 42 participants were enrolled, most of whom were people of colour who had not participated in research before. Among them, 40 participants provided at least one response to a same-day conversation circle feedback form, which reflected consistently positive experiences with BRAID. This was consistent with evidence from the post-series survey, in which every one of the 36 respondents stated that they would either definitely (83.3%, N = 30/36) or probably (16.7%, N = 6/36) recommend participation in BRAID to someone like them. Of note, 91.7% (N = 33/36) had already disseminated health information learned through BRAID downstream and 84.4% (N = 27/32) indicated that BRAID strengthened their trust in science and research, highlighting unique and distinguishing features of the model.

CONCLUSIONS: Our quantitative evidence suggests that BRAID is effective, efficient and scalable, with experiential evidence supporting that it is reproducible. These factors suggest that BRAID implementation can facilitate rapid, bidirectional information sharing that builds trust between healthcare organizations and communities. This has laid the groundwork for an LHCC in the Bronx, with the potential to be adopted by healthcare organizations elsewhere.

PMID:39972399 | DOI:10.1186/s12961-025-01289-w

Neurol Res Pract. 2025 Feb 20;7(1):8. doi: 10.1186/s42466-025-00365-4.

ABSTRACT

BACKGROUND: Several publications have raised concerns that female stroke patients may be at a disadvantage when accessing stroke treatment services. These publications have found significant regional differences in the provision of stroke treatment to male and female patients. In this study, we provide current nationwide data on stroke management differences between men and women in Germany.

METHODS: This large retrospective cohort study used national datasets from the German Federal Statistical Office for 2017-2022. We examined differences between female and male stroke patients in terms of case volume, intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), stroke unit (SU) treatment, intrahospital mortality, and prevalence of atrial fibrillation (AF).

RESULTS: Data from more than 1.3 million hospitalised stroke patients were included. Forty-seven percent of the patients were female. Female patients were older and more frequently ≥ 80 years old (50.3% versus 29.4%). Rates of IVT (16.3% versus 16.3%) were similar for both sexes but higher in females when adjusted for age. MTE rates (8.2% versus 6.3%) were consistently higher in female patients across all age groups. Female patients had higher rates of intrahospital mortality (9.1% versus 6.2%), and admission to SUs (73.6% versus 76.0%) was less common. Treatment rates in intensive care units were similar (10.6% versus 10.5%). AF, a surrogate for embolic (and more severe) strokes, was more prevalent in females (32.6% versus 25.4%).

CONCLUSIONS: We found no evidence that female stroke patients in Germany face any disadvantage in accessing stroke treatment services. Acute stroke treatment rates were generally similar or higher when compared to males. Higher intrahospital mortality and lower SU rates were attributed to greater age, comorbidities, and stroke severity. However, the differences were not fully explained when adjusting for AF and age. Further research is needed on sex differences in stroke mechanisms and outcomes.

PMID:39972395 | DOI:10.1186/s42466-025-00365-4

Glob Health Res Policy. 2025 Feb 19;10(1):5. doi: 10.1186/s41256-024-00398-3.

ABSTRACT

BACKGROUND: Although the implementation of a hierarchical medical system (HMS) has been shown to improve the allocation of medical resources and patient health-seeking behaviour, its role in patient’s perceived quality of primary care remains unexplored. This study aimed to assess the impact of HMS implementation on rural and urban residents’ perceived quality of primary care.

METHODS: Data were obtained from the China Family Panel Study for 2012, 2014, 2016, and 2018. A total of 40,011 rural and 22,482 urban residents were included in the research participants for analysis. This study adopted a quasi-natural experimental design, and the multiple-period difference-in-differences method was used to capture changes in patient’s perceived quality of primary care before and after the introduction of HMS.

RESULTS: We found that HMS implementation declined the perceived quality of primary care by an average of 18% among rural residents (OR: 0.82, 95% CI 0.68-0.99), while there was no significant change among urban residents (OR: 1.13, 95% CI 0.87-1.46). There was a 24% reduction in the perceived quality of primary care (OR: 0.76, 95% CI 0.61-0.96) one year after HMS among rural residents, and there was no statistically significant difference two years after HMS. After HMS implementation, the level of perceived quality of primary care by rural patients with chronic diseases decreased by 72% (OR: 0.28, 95% CI 0.11-0.78).

CONCLUSIONS: HMS has a limited effect on improving residents’ perceived quality of primary care, especially for those living in rural areas. Policymakers are suggested to establish a quality monitoring system that incorporates patient experience as an essential standard to systematically evaluate the impacts of the HMS, with more efforts being put into helping vulnerable groups such as residents under 60 years old and patients with chronic diseases.

PMID:39972386 | DOI:10.1186/s41256-024-00398-3